Gallstones presence can lead to numerous symptoms and complications when they are within the gallbladder. When they escape the gall bladder and enter the common bile duct then the complications are different and can be life threatening as well.

These can cause vague symptoms as nausea, change in taste or mild fever.

Flatulent Dyspepsia
Commonly observed in obese, fatty women complaining of heartburn, abdominal discomfort, belching and fatty food intolerance.

Symptoms and complications of Gallstones when inside the gallbladder:

i) Pain / Gallstone colic
Medically termed as biliary colic. Its Severe, colicky pain felt mostly in the upper abdomen. Pain can shoot to the back or between the shoulder blades often associated with vomiting, restlessness, and sweating. Strong pain killers, clinical assessment and sometimes admission in the hospital is required.

Dyskinesia of gallbladder (poorly contracting gallbladder):

Patients can have gall bladder pain even without gallstones. Specialist surgical opinion will help to solve this mystery; which can be debilitating for patients and can take a long time to diagnose.

ii) Infection / Inflammation 
Acute Cholecystitis in medical terms occurs when a gallstone gets lodged in the neck of the gallbladder (Hartmann’s pouch), causing bile stasis leading to gallbladder inflammation. Cholecystitis is an acute condition and can cause severe pain, vomiting, nausea, and fever. Strong pain killers, clinical assessment, blood tests, antibiotics and admission in the hospital is required.

Acalculous Cholecystitis (Infection of Gall bladder without any stones):

This condition is noted in very sick patients and requires specialist input of an experienced surgeon. What may look like an inflamed gallbladder on scan be a gangrenous gall bladder.

iii) Mucocele
It occurs when a stone is completely blocking the gall bladder outlet blocking the cystic duct or the Hartman’s pouch, but there is no infection. This leads to a distension of the gall bladder and pain. One notices “white bile” in the gall bladder at surgery. Surgery is required in this situation.

iv) Empyema
It’s a completely blocked gall bladder like a mucocele with superadded infection as well. Its like an abscess, where simple antibiotics will not work. Emergency decompression or removal of gall bladder is required after appropriate assessment by a surgeon in a hospital.

v) Perforation of gall bladder
Perforation in abdominal cavity is a rare condition. Impacted stone, diabetes, or virus can precipitate an empyema causing gangrene of gallbladder and perforation.

High-grade fever, chills, and pain in the abdomen are common symptoms. Emergency treatment in a hospital with immediate surgery can be lifesaving in this situation.

vi) Fistula formation:
In case on chronic cholecystitis a stone in gall bladder can erode into duodenum or large bowel, leading to Cholecystoduodenal fistula or a Cholecystocolonic fistula. This can happen silently and may come to attention while having tests done for any reason. Generally these can be left alone and observed it not giving any symptoms to the patient.

vii) Mirizzi’s Syndrome:
A stone impacted in the Hartman’s pouch or the cystic duct if not causing a full blockage of the gallbladder outlet can keep getting bigger and can fistulate (erode) into the common bile duct.This can lead to pain, infection, jaundice or even sepsis and requires input from a specialist surgeon urgently. This should ideally be dealt with Laparoscopically and may also require an ERCP (Endoscopic Retrograde Cholangio Pancreaticography).

viii) Small bowel Obstruction / Gallstone Ileus:
A large gallstone escaping the gall bladder due to Cholecystoduodenal fistula can get impacted in small bowel and cause a complete blockage requiring emergency surgery to relive the obstruction and remove the gallstone from small bowel.

ix) Gallbladder Cancer:
The likelihood of cancer is not common, but chronic cholecystitis or cholelithiasis can pose an increased risk of gallbladder cancer. Gallbladder polyps and Porcelain gall bladder are also considered as risk factors for gallbladder cancer.

Gall Bladder cancer carries a poor prognosis.

1. Complications of Gallstones in the Common Bile Duct (CBD)

Though the complications are fewer than of the stones within the gallbladder but these are much more serious and potentially life threatening.

x) Obstructive Jaundice:
Obstruction to the bile outflow causes obstructive jaundice. Jaundice with yellow skin, yellow eyes, dark colored urine, clay-colored stools, and itching are the usual symptoms.

One need to see a surgeon to get the advice and treatment.

Generally, one requires ERCP and Laparoscopic Cholecystectomy.

xi) Cholangitis:
It is the bacterial infection of common bile duct causing abdominal tenderness, chills, fever, and rigors. This is a very scary situation for the patient and requires urgent attention, admission in the hospital and antibiotic treatment with appropriate decompression of the system.

xii) Gallstones Pancreatitis 
There is no greater or worse complication of gallstones than acute pancreatitis or inflammation of pancreas due to a gallstone blocking the common opening of the common bile duct with the pancreatic duct.

Patient requires emergency admission in the hospital and appropriate care, investigations and treatment.

In mild pancreatitis one may get better in a day or two. In moderate cases one may lose the function of pancreas and become diabetic for life long. In some cases of severe pancreatitis, this may me life threatening.

Clinicians suggesting or patients considering wait and watch on their gallstones must consider this small but potentially life-threatening complications of gallstones in their mind.